Dr. Gerard M. Nadal

Sebelius’ sensible decision

Dr. Gerard M. Nadal
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The recent overruling of the FDA decision to sell Plan B over the counter (OTC) to children as young as eleven years of age has engendered no small amount of outrage by proponents of the FDA plan, and HHS Secretary Kathleen Sebelius has come in for severe criticism from women’s health and advocacy groups. Setting aside for a moment the undercurrent of abortion and the distrust between warring parties over the issue, this decision by Secretary Sebelius is a victory for the very children the FDA purports to serve and protect.

According to FDA labeling on Plan B:

“Ectopic pregnancies account for approximately 2% of all reported pregnancies. Up to 10% of pregnancies reported in clinical studies of routine use of progestin-only contraceptives are ectopic.”

That represents a five-fold increase in the incidence of a potentially fatal side effect of the drug’s usage in those taking the drug. The very issue proponents of OTC Plan B sale cite for selling to young adolescents, their fear of parental knowledge and involvement in their sex lives, heightens the risk of fatality in the very young.

Aiding and abetting the young in skirting parental involvement fosters a do-it-yourself gynecology where side-effects such as cramping, nausea, vomiting, and bleeding can serve to reinforce and heighten the fear and distrust that led to the child’s self-medication in the first place. Plan B taken by a child with an existing and untreated endometriosis can lead the child into thinking that the lower abdominal pain and heavy bleeding of a resulting ectopic pregnancy may well be her monthly norm. Such a mistake can be fatal, but what is an already fearful and distrustful child to do? It is entirely unreasonable to expect children, who are notoriously ignorant of their changing physiology, to engage in self-differential diagnosis and admit their clandestine activities to the parents they fear and distrust.

In research conducted by Family Health International (FHI), January, 2003.

“… the sine qua non of an OTC-switch is that patients should be capable of self-medicating by reading the drug’s package insert. The above label comprehension tests for Plan B indicate that safe self-medication is not possible for a significant segment of the population. For example, only 75% of all respondents answered correctly that Plan B should not be taken in the presence of unexplained vaginal bleeding. Among the low-level literacy group that figure declined to 69%. Furthermore, only 67% of all respondents understood that Plan B is designed to serve as a backup for regular contraception methods, not a replacement. Among those of low-literacy this figure dropped to 46%; whereas for women of high literacy the figure was 78%. Obviously, many patients do not understand much of the drug’s package insert, which argues against FDA approval of EC OTC.”

If there are any doubts about the ability of children and teens to self-prescribe such medication and act responsibly, NPR published a story about the work of Harvard’s Dr. Frances Jensen that shows how the child and adolescent brain is underdeveloped in the areas responsible for critical and prudent decision making:

She learned that that it’s not so much what teens are thinking — it’s how.

Jensen says scientists used to think human brain development was pretty complete by age 10. Or as she puts it, that “a teenage brain is just an adult brain with fewer miles on it.”

But it’s not. To begin with, she says, a crucial part of the brain — the frontal lobes — are not fully connected. Really.

“It’s the part of the brain that says: ‘Is this a good idea? What is the consequence of this action?’ ” Jensen says. “It’s not that they don’t have a frontal lobe. And they can use it. But they’re going to access it more slowly.”

Do-it-yourself gynecology is bad medicine for the young, and our daughters deserve better than such callous disregard for their lack of knowledge of their bodies, lack of impulse control, and lack of sufficient neurological development to enable them to make reasonable and informed decisions. For those who lack trust in the experience and wisdom of the adults who know them best, it is all the more imperative that we ensure they don’t fall victim to pharmaceutical merchants and their allies who would exploit the callowness of their youth.

For the women’s groups howling with rage at Sebelius, I remember a time when feminism demanded medicine’s best for women, not do-it-yourself gynecology for our teenage and pre-teen daughters.

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An open letter to the biomedical community on Down Syndrome and other undesirable life

Dr. Gerard M. Nadal
Dr. Gerard M. Nadal

This letter is addressed to every physician, scientist, and genetic counselor who believes in a eugenic agenda that targets the unborn specifically because of diagnosed genetic anomalies. It asks a series of penetrating questions that invite thoughtful response, and are not meant to be rhetorical.

The first question is: WHO?

Who taught you in medical school or graduate school that we doctors of science and medicine are the custodians of the human gene pool? Who was it that told you it was your job to keep that pool “clean?” They are serious questions, as I never encountered this philosophy, let alone mandate, in my premed studies at Columbia University, grad studies at St. John’s University, or post-doctoral studies at the City University of New York. Neither in the Ivies, Catholic, or Public universities did I ever encounter this mandate that has seized hold in our hospitals. Whence comes this thinking?

In my undergraduate studies in the 70′s and 80′s liberal arts professors taught extensively about the corruption of the Third Reich, and the eugenic agenda in Hitler’s camps. What we were never taught was that this agenda predated Hitler and arose within the medical community of the 1920′s in Germany. Regardless, the properly educated man or woman in American universities in the 70′s and 80′s was taught that eugenics was repugnant, Master Race and all of that stuff… It leads to the next question:

HOW?

How have we progressed from that understanding to where we are today? How is it that we have come to view genetic anomalies as so terrifyingly painful that those who bear them are deemed “incompatible with life,” which is strikingly similar to Hitler’s, “Life unworthy of Life?” On what basis do you make such an assessment, especially in the case of Down Syndrome? Is this rooted in firsthand clinical experience? It can’t be, as these children and adults are some of the most beautiful and happy individuals among us. How is it that we celebrate “diversity’ with near-fanaticism in society while we shoot for genetic homogeneity with similar near-fanaticism? That of course leads to the question:

WHAT?

What is it that you believe you have been entrusted with that leads to this neo-eugenics? When I went to graduate school, we were entrusted with great knowledge of biology across the spectrum of life, and in my course of studies, great knowledge of human and microbial physiology. We were entrusted with the knowledge and training in molecular biology, techniques so powerful that they have equal ability to destroy life on earth as well as advance the cause for life on earth. What we did not receive enough of was training in ethics, and not the sort of algorithm flow chart-based policy crap devoid of any training in metaphysics and human anthropology. I received all of that in undergrad, thank God. It was expected of us that we would use this great knowledge and power only for good, but therein lies the problem.

How do we define the good? Who defines the good? What is the good?

It’s easy for those of us who were obviously born with all of the genetic capability to earn doctorates to look down upon the disenfranchised with disdain. It comes from an insecurity within that says, “I can’t imagine living like that,” which is precisely the soil in which a eugenic mentality takes root. A little guilt added in to spice up the toxic brew, and here we are. But ask yourself this question.

If you rise above the genetics and epigenetics and consider the quality of life to which you appeal in your headlong pursuit of stamping out the unfit, what training do you have in anthropology, psychology, sociology, comparative religion, transcultural psychology, aesthetics, philosophy? How well did you apply yourself to these studies when you were in pre-med, or were these the B.S. courses you needed to endure on the way to medical or graduate school?

I would submit that most physicians and scientists I have met who are pro-choice are severely deficient in these areas, and as such cannot render an informed opinion as regards quality of life, and only speak from their very narrow and cramped worldview.

The new colonialism.

Of course, this all begs the further question:

When?

When was it that we stopped looking for cures and enhanced therapies, and started taking the cheap way out? When did death and non-existence become the answer, rather than healing and wholeness? When did we receive a mandate to kill every baby we could in order to aid the patient in avoidance of suffering?

I would submit that the answers reside in the radicalization of the liberal arts over the past thirty years, and in the watering down of the college curriculum in that time. It’s a formation issue, from my perspective, one that has left many of our finest and brightest physicians and scientists impoverished and without the necessary spiritual and intellectual protections against the power of our biotechnology to twist and distort its practitioners.

Do you disagree?

I’m open to feedback and answers to the questions.

Reprinted with permission from GerardNadal.com.

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Killing gay men with victimology

Dr. Gerard M. Nadal
Dr. Gerard M. Nadal
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Building on yesterday’s post regarding CDC’s documentation of the continued rise in HIV, Syphilis, and Gonorrhea among men who have sex with men (MSM), in almost every document on the matter CDC offers the following:

Complex issues like homophobia and stigma can also make it difficult for gay and bisexual men to seek appropriate care and treatment.

That’s code for the principled stand taken by people of faith. In other words, it’s our fault that many MSM do not seek appropriate medical treatment. It’s because of our deeply held and abiding religious beliefs that MSM do not seek confidential and professional care. That is a very ominous declaration by a governmental agency; to declare an abiding religious belief as hatred so profound that it stigmatizes and drives a public health calamity. It makes bigotry against orthodox Christianity, Judaism, and Islam a key component of STD epidemiology; one that will need to be eliminated as one of the root causes.

It’s also pretty patronizing toward MSM.

The truth of the matter is that physicians and nurses are bound to nonjudgmentalism in the delivery of services. But in the warped perspective that is gay activism and hedonism, any counseling against promiscuity, which is a major cultural element in many quarters of the gay community, is bound to be interpreted as homophobia. No critique, even if sound lifesaving advice, is tolerable for some.

So it is the fault of those who oppose the lifestyle on either principled moral ground, or on principled medical ground. Changing mores, as we are seeing, does not change the laws of nature, particularly where infectious disease is concerned. Unlike humans, the microbes always remain true to their nature.

Back to the big lie:

Complex issues like homophobia and stigma can also make it difficult for gay and bisexual men to seek appropriate care and treatment.

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The photo essay in this post shows images from New York’s Gay Pride Parade, images that debunk the myth of enduring stigma that would prevent seeking confidential treatment. The juxtaposition is remarkable. Note the throngs of well-wishers several rows deep (Contrasted with the sparse attendance at Memorial Day parades). Note, too, the costuming of the participants. These are among the thousands of images available by Googling “Gay Pride Parade”. They are also the cleanest.

Finally, note the police officers marching, and the throngs in the line of march.

Stigma? Where?

Helping the MSM community out of the holocaust it is in requires dealing with the truth openly and honestly, as openly as the pride expressed at parades around the world. Blaming those with differing world views merely panders politically to the very community with whom CDC needs to be most concerned, and creates needless ill will, which then generates the stigma it claims to be driving this epidemic.

That makes CDC, and not the faith community, the source of stigma.

MSM deserve better, and so do we.

Reprinted with permission from  Gerard Nadal

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Why HIV, syphilis, and gonorrhea are rising among homosexuals

Dr. Gerard M. Nadal
Dr. Gerard M. Nadal
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This week the Centers for Disease Control and Prevention released its annual report, Sexually Transmitted Disease Surveillance 2012, to whining among journalists that the reason for the documented continued rise in syphilis (primarily affecting homosexuals) has more to do with homophobia than anything else. Consider the following from Bloomberg News:

Gonorrhea and syphilis are on the rise in the U.S., mostly in men who have sex with men (MSM), a trend the government said is linked to inadequate testing among people stymied by homophobia and limited access to health care.

The rate of new gonorrhea cases rose 4 percent in 2012 from the year before, while syphilis jumped 11 percent, the U.S. Centers for Disease Control and Prevention said today in a report. Rates for chlamydia, the most common of the bacterial sexually transmitted diseases, gained less than 1 percent.

While all three diseases are curable with antibiotics, many people don’t get tested as recommended, said Gail Bolan, the director of the CDC’s STD prevention division. That’s especially the case for syphilis, where the rise is entirely attributable to men, particularly those who are gay or bisexual.

“We know that having access to high-quality health care is important to controlling and reducing STDs,” Bolan said in a telephone interview. “Some of our more-vulnerable populations don’t have access. There are a number of men who come in to our clinic for confidential services because they’re too embarrassed to see their primary care doctors.

If they are eschewing their primary care physicians, then MSM actually do have access to quality healthcare. They choose clinics, instead.

The whine in the article then continues with George W. Rutherford, a professor of epidemiology at the University of California at San Francisco who captures something of the hedonistic disorder driving the numbers:

“With most of these populations, having a sexually transmitted disease from having sex with another man is highly stigmatized,” he said. “They’d rather not get tested for HIV, syphilis, or whatever. They don’t want it to show up on their records.”

Neither do married men want diseases transmitted by their mistresses showing up on records. That said, there is an understandable stigma surrounding gay and bisexual men whose community has become the engine of disease in the United States where HIV, Syphilis, and Gonorrhea are concerned. Far from being ten percent of the population, as they claim, CDC points to the fact that MSM constitute two percent of the population. Lest any doubt the force of this engine, here is the CDC fact sheet on HIV Among Gay, Bisexual, and Other Men Who Have Sex With Men:

Gay, bisexual, and other men who have sex with men (MSM) represent approximately 2% of the United States population, yet are the population most severely affected by HIV. In 2010, young MSM (aged 13-24 years) accounted for 72% of new HIV infections among all persons aged 13 to 24, and 30% of new infections among all MSM. At the end of 2010, an estimated 489,121 (56%) persons living with an HIV diagnosis in the United States were MSM or MSM-IDU.

Some of the real reasons why STD’s are on the rise among gay and bisexual men were covered just a few weeks ago in the New York Times. The CDC and other epidemiologists are pointing toward the upward trend in unprotected sex:

Federal health officials are reporting a sharp increase in unprotected sex among gay American men, a development that makes it harder to fight the AIDS epidemic.

The same trend has recently been documented among gay men in Canada, Britain, the Netherlands, France and Australia, heightening concerns among public health officials worldwide.

According to the Centers for Disease Control and Prevention, the number of men who told federal health investigators that they had had unprotected anal sex in the last year rose nearly 20 percent from 2005 to 2011. In the 2011 survey, unprotected sex was more than twice as common among men who said they did not know whether they were infected with H.I.V.

Being tested even once for H.I.V. is associated with men taking fewer risks, whether the test is positive or negative, health experts say. But the most recent survey found that a third of the men interviewed had not been tested in the past year.

Rather than homophobia, the article goes on to give evidence that being tested even once is associated with a reduction in risk-taking behavior, and that the rise in unprotected sex has continued unabated since 1997. Read the rest here. That rise in unprotected sex, with condoms with some value, is accompanied by the real reason why STD’s, including HIV, Syphilis, and Gonorrhea are on the rise:

Nondisclosure of serostatus.

In a 2006 study published in the journal, AIDS Behavior (AIDS Behav. 2006 September; 10(5): 495–507.) Duru, et al. studied the behaviors of a representative sample of HIV-positive homosexuals, heterosexual men, and women. The results are shocking. Sixty percent of homosexual men failed to report their serostatus to all partners, compared to thirty-four percent of heterosexual men, and twenty-seven percent of women. More shocking than those numbers is the breakdown of nondisclosure according to clinical stage of the disease.

Thirty-seven percent of those Asymptomatic with HIV failed to disclose their status to every partner.
Forty-six percent of those Symptomatic with HIV failed to disclose their status to every partner.
And a staggering Fifty-one percent with full-blown AIDS diagnosis failed to disclose their status.

In studies and commentary on the issue of nondisclosure, fear of rejection is often cited as the driving force. While quite legitimate, the act of nondisclosure says something about the hedonistic predisposition of the offenders. They are more concerned about their acceptance in bed, than the life, health, and safety of the people whom they knowingly place at risk. They hold in low esteem the unsuspecting individual, denying them the right to make a decision for themselves. It is part of the objectification of the other inherent in sexual promiscuity.

In recent years, many HIV positive gay men have been quoted as saying that the prospective partner needs to take responsibility for the potential risks associated with sex; an action that then absolves the HIV-positive partner from the need to disclose. As rationalizations go, there is a large kernel of truth at the core of this one, but not enough to assuage moral and epidemiological culpability in this ongoing, slow-motion train wreck. No, the truth of the matter is that fifty-six percent of all HIV cases in this country are concentrated in a group representing two-percent of the population. That’s not because of persecution from without, but a suicidal impulse from within.

UPDATE: Of course, it doesn’t help that Planned Parenthood teaches young people that disclosing one’s HIV status is optional. Read it here.

Reprinted with permission from Gerard Nadal

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